REACH Partnership

REACH Collaboration provide professional and confidential youth counselling for young people aged from 11-19 years across the County of Northamptonshire.

REACH are five existing, highly regarded agencies:

• The Lowdown • Service Six • Time2Talk
• CHAT Youth Counselling • Youth Works

The service is funded by the CCG and Public Health in Northamptonshire. Many of these agencies provide other services for young people to support their mental health. Just click on the logos for further information and to visit their websites.

Service Six, 15 Sassoon Mews,
Wellingborough, NN8 3LT

Time2Talk,
The Abbey, Market Square,
Daventry, NN11 4XG

CHAT, The Courthouse,
1 Mill Road, Oundle, PE8 4BW

Youth Works,
Keystone Centre, 97 Rockingham Rd,
Kettering, NN16 9HX

Thank you for connecting with us. We will respond to you as soon as possible.

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Aspire Higher: REACH Referrals

THIS FORM IS FOR REMOTE SUPPORT meaning assistance will be given over the telephone or video calls.*Be aware that young people under the age of 16 will require parent / guardian consent to download the Zoom application onto personal devices.

Please note: Only students eligible for 'Uni Connect' can be referred into this service.

*What is the student's preferred method of support?

Telephone

Video Call

*Is this referral being completed in collaboration with the student and have they consented to engaging with this support?

Yes

SORRY - before proceeding we require you to gain consent from the student. Please come back once you have this and select YES (above) to continue...

*Year group of student?(must be in school years 9 to 13)

*Participating Schools (for REACH referrals)(Please select one - if your school is not shown please select 'MY SCHOOL IS NOT LISTED')

NOTE: REACH referrals are currently only available to these participating schools. To discuss potentially having your school added to this list, please contact:

Deborah Patton @ Aspire Higher
Email: Deborah.Patton@northampton.ac.uk | Tel: 07593 130181

Step 1/5: About the Student

*First Name/s

*Surname

*Date of Birth

*Age

*Ethnicity

*Gender

*Here are some examples of ethnicity (you can also describe in your own words). **CIS gender is someone whose gender identity matches their sex assigned at birth.

*Full Address - including door number, street name & postcode

*Disability (if any)(or enter 'NONE' if not applicable)

*NHS Number(if unknown, enter 'X' to permit a request for this)

*Student Telephone Number(for appointment reminders)

*Student Email Address(for correspondence)

Step 2/5: Keeping In Touch

Please provide an EMERGENCY contact name and phone number (in addition to the student's appointment contact details entered previously)

*Emergency Contact Name

*Emergency Contact Number

Who can we NOT speak to at home about this referral?

*How may we contact the student for marketing purposes?(e.g. Promotion of other services available to young people - please select 1 or more)

Phone

Post

Text

Other

No Thanks

As 'OTHER' was selected, please specify another method of contact:

Step 3/5: Reason for REACH Referral

*What issue/s is the student currently experiencing?(please select ALL which apply)

Abuse

Anger

Anxiety

Bereavement

Depression / Low Mood

Domestic Abuse

Eating Disorder

Family

Low Self-Esteem

OCD

Online Grooming

Self-Harm

Sleep Difficulties

Suicidal

Trauma / PTSD

Violent Behaviour

Other (specify below)

*Detailed reason for this referral to REACH (please provide further information about the student's situation)

Step 4/5: GP Details (information about the student)

*GP Name or Surgery

*GP Phone Number

GP Email Address

*GP Address (inc. postcode)

*Is the student's GP aware of this referral?

Yes

*Is an Early Help Assessment EHA in place?

Yes

*Are other professionals currently involved?

Yes

As YES to 'other professionals', please specify their Name and Agency

*Are there any other relevant details you think we should be aware of?(e.g. such as health issues or disabilities - please specify below)

Step 5/5: Staff Member / Referrer Details

Finally, please provide details of the Staff member to be contacted in order to schedule the sessions during school hours.

*Staff Full Name

*Staff Phone Number

*Staff Email Address

REACH Partnership

REACH Collaboration provide professional and confidential youth counselling for young people aged from 11-19 years across the County of Northamptonshire.

• The Lowdown • Service Six • Time2Talk • CHAT Youth Counselling • Youth Works

Thank you for connecting with us. We will respond to you as soon as possible.

REACH ~ Youth Counselling for Northamptonshire

• The Lowdown • Service Six • Time2Talk
• CHAT Youth Counselling • Youth Works